Use of primary care data for identifying individuals at risk of cardiovascular disease
Holt, Tim A. (2009) Use of primary care data for identifying individuals at risk of cardiovascular disease. PhD thesis, University of Warwick.
WRAP_THESIS_Holt_2009.pdf - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
Official URL: http://webcat.warwick.ac.uk/record=b2339271~S15
The aim of this research was to explore the potential of routinely collected primary
care data to support the identification of individuals for cardiovascular risk reduction.
The work involved a systematic literature review of reminder interventions operating
at the point of care; a randomised controlled trial of a novel software tool to facilitate
the targeting of individuals at risk of cardiovascular disease; and an exploration of
qualitative issues relevant to the challenge of cardiovascular risk reduction in current
The Systematic review resulted in a narrative synthesis and a meta-analysis.
It concluded that reminder interventions are generally effective at changing
practitioner behaviour, but the effect is inconsistent, probably dependent on
organisational context, and difficult to predict.
The e-Nudge trial involved 19 practices in Coventry and Warwickshire, who
used the e-Nudge software tool for two years. This tool was programmed for the
project by the clinical software company EMIS. Whilst the primary outcome
(cardiovascular event rate) was not significantly reduced in this timescale, a
beneficial effect was demonstrated on the adequacy of data to support risk estimation
and on the visibility of the at risk population. A new means of addressing the problem
of undiagnosed and late-diagnosed diabetes was also discovered.
Qualitative aspects of this area of care are presented through a discussion of
ethical issues, a limited series of interviews with members of the public included in
the appendix, and extensive field notes taken throughout the research. These provide
some context in support of the e-Nudge trial.
Routinely collected data of UK general practice provide a potentially rich
resource to support primary cardiovascular disease prevention, but practical, ethical
and conceptual issues must all be addressed to optimise their impact. This conclusion
forms the thesis to be explored and justified through this dissertation.
|Item Type:||Thesis or Dissertation (PhD)|
|Subjects:||R Medicine > RC Internal medicine|
|Library of Congress Subject Headings (LCSH):||Cardiovascular system -- Diseases -- Diagnosis, Primary care (Medicine) -- Databases, Primary care (Medicine) -- Software|
|Official Date:||December 2009|
|Institution:||University of Warwick|
|Theses Department:||Warwick Medical School|
|Supervisor(s)/Advisor:||Thorogood, Margaret ; Griffiths, Frances|
|Extent:||xxiii, 281,  leaves : charts|
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